Sjoerd P F T Nota1, Silke A Spit1, Timothy Voskuyl1, Arjan G J Bot1, Michiel G J S Hageman1, David Ring2. 1. Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 2. Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: dring@partners.org.
Abstract
BACKGROUND: Patients in other countries use fewer opioids than patients in the United States with satisfactory pain relief. OBJECTIVE: This study tested the null hypothesis that opioid intake after orthopedic surgery does not influence satisfaction with pain management. METHODS: A total of 232 orthopedic surgical inpatients completed measures of pain self-efficacy and symptoms of depression at enrollment and commonly used measures of pain intensity, satisfaction with pain relief, and satisfaction with hospital staff attention to pain approximately 14 days after surgery. Inpatient opioid intake per 24-hour period was quantified. RESULTS: At a phone evaluation approximately 2 weeks after discharge from the hospital, patients who were always satisfied with their pain relief in hospital and always satisfied with staff attention to pain used significantly less opioids on day 1 compared with patients who were not always satisfied. There were no differences in satisfaction by type of surgery. The final multivariable model for not always satisfied with pain relief included greater opioid use on day 1 (odds ratio = 1.2), and preadmission diagnosis of depression (odds ratio = 2.6). Greater opioid use on day 1 was the only factor associated with less than always satisfied with the staff attention to pain relief (odds ratio = 1.3). CONCLUSIONS: Patients who take more opioids report less satisfaction with pain relief and greater pain intensity. Evidence-based interventions to increase self-efficacy merit additional study for the management of postoperative pain. LEVEL OF EVIDENCE: Prognostic, Level 1.
BACKGROUND:Patients in other countries use fewer opioids than patients in the United States with satisfactory pain relief. OBJECTIVE: This study tested the null hypothesis that opioid intake after orthopedic surgery does not influence satisfaction with pain management. METHODS: A total of 232 orthopedic surgical inpatients completed measures of pain self-efficacy and symptoms of depression at enrollment and commonly used measures of pain intensity, satisfaction with pain relief, and satisfaction with hospital staff attention to pain approximately 14 days after surgery. Inpatient opioid intake per 24-hour period was quantified. RESULTS: At a phone evaluation approximately 2 weeks after discharge from the hospital, patients who were always satisfied with their pain relief in hospital and always satisfied with staff attention to pain used significantly less opioids on day 1 compared with patients who were not always satisfied. There were no differences in satisfaction by type of surgery. The final multivariable model for not always satisfied with pain relief included greater opioid use on day 1 (odds ratio = 1.2), and preadmission diagnosis of depression (odds ratio = 2.6). Greater opioid use on day 1 was the only factor associated with less than always satisfied with the staff attention to pain relief (odds ratio = 1.3). CONCLUSIONS:Patients who take more opioids report less satisfaction with pain relief and greater pain intensity. Evidence-based interventions to increase self-efficacy merit additional study for the management of postoperative pain. LEVEL OF EVIDENCE: Prognostic, Level 1.
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